Surgical Site Infection Prevention: The Importance of Operative Duration and Blood Transfusion-Results of the First American College of Surgeons-National Surgical Quality Improvement Program Best Practices Initiative
Surgical Site Infection Prevention: The Importance of Operative Duration and Blood Transfusion-Results of the First American College of Surgeons-National Surgical Quality Improvement Program Best Practices Initiative
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DOI：
10.1016/j.jamcollsurg.2008.08.018
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发表时间：
2008-12-01
影响因子：
5.2
通讯作者：
Khuri, Shukri F.
中科院分区：
文献类型：
--
作者：
Campbell, Darrell A., Jr.;Henderson, William G.;Khuri, Shukri F.
背景：手术部位感染（SSI）仍然是手术中的一个重要问题。美国外科医生学会-国家外科质量改进计划（ACS-NSQIP）最佳实践计划比较了117家私营部门医院的过程和结构特征，以确定旨在防止SSI.Study Design的最佳实践：使用标准NSQIP方法，我们确定了20个低离群值和13个高离群值医院SSI使用的数据从ACS-NSQIP在2006年。每个医院都进行了护理过程调查，并对五家医院进行了现场访问。在患者特征、手术变量、结构变量和护理过程方面，对低离群值医院和高离群值医院进行了比较。SSI异常值较高的医院有较高的受训者与床位比率（0.61对0.25，p < 0.0001），手术时间明显更长（128.3 +/- 104.3分钟对102.7 +/- 83.9分钟，p < 0.001）。在低离群值医院接受手术的患者不太可能出现贫血（4.9% vs 9.7%，p = 0.007）或接受输血（5.1% vs 8.0%，p = 0.03）。一般而言，低异常值医院和高异常值医院之间的围手术期政策和实践非常相似，尽管研究中心访视者很容易识别出低异常值医院。总体而言，低离群值的医院规模较小，在提供护理的效率，并经历了一点手术人员turnovers.CONCLUSIONS：我们的研究结果表明，以证据为基础的SSI预防措施不容易区分以及表现不佳的医院。但是，医院的结构和护理过程的特点被发现有一个良好的结果显着相关。（美国科尔外科杂志2008;207：810-820。(C)2008年美国外科医生学会）
BACKGROUND: Surgical site infections (SSI) continue to be a significant problem in surgery. The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Best Practices Initiative compared process and structural characteristics among 117 private sector hospitals in an effort to define best practices aimed at preventing SSI.STUDY DESIGN: Using standard NSQIP methodologies, we identified 20 low outlier and 13 high outlier hospitals for SSI using data from the ACS-NSQIP in 2006. Each hospital was administered a process of care survey, and site visits were conducted to five hospitals. Comparisons between the low and high outlier hospitals were made with regard to patient characteristics, operative variables, structural variables, and processes of care.RESULTS: Hospitals that were high outliers for SSI had higher trainee-to-bed ratios (0.61 versus 0.25, p < 0.0001), and the operations took significantly longer (128.3 +/- 104.3 minutes versus 102.7 +/- 83.9 minutes, p < 0.001). Patients operated on at low outlier hospitals were less likely to present to the operating room anemic (4.9% versus 9.7%, p = 0.007) or to receive a transfusion (5.1% versus 8.0%, p = 0.03). In general, perioperative policies and practices were very similar between the low and high outlier hospitals, although low outlier hospitals were readily identified by site visitors. Overall, low outlier hospitals were smaller, efficient in the delivery of care, and experienced little operative staff turnover.CONCLUSIONS: Our findings suggest that evidence-based SSI prevention practices do not easily distinguish well from poorly performing hospitals. But structural and process of care characteristics of hospitals were found to have a significant association with good results. (J Am Coll Surg 2008;207: 810-820. (C) 2008 by the American College of Surgeons)